Knowledge and practices relating to malaria in a semi-urban area of Cameroon: choices and sources of antimalarials, self-treatment and resistance

Introduction: Malaria is a major public health problem in Sub-Saharan Africa where it kills a child under the age of five every 30 seconds. In Cameroon, malaria accounts for 40-45% of medical consultations, 57% of hospitalization days and 40% of mortality among children below 5 years. Community knowledge and practices can enhance the fight against this disease. The aim of the study was to make a local analysis of the people’s knowledge and practices relating to the choice and source of antimalarials, self-medication, malaria dosage and resistance in order to establish behavioural baseline and epidemiological determinants and their implications for malaria control. Methods: The design was a community-based cross-sectional study in a semi-urban setting. The survey consisted of 253 volunteer participants (from among 350 contacted) from different socio-demographic backgrounds to whom structured questionnaires were administered. The respondent’s consent was sought and gained and subjects who could not read or write or understand English language were communicated to in the local language. The questionnaire was administered by trained interviewers according to the schedule of the respondent. The data was analysed using SPSS. Results: Antimalarials commonly cited for malaria treatment were chloroquine (26.1%) and nivaquine (14.6%) and analgesics: panadol (23%) and paracetamol (12.3%) including native drugs (6.3%). 141(55.7%) (95% confidence interval (CI): 49.6–61.8%) participants practiced self-medication of malaria. 26.1% participants knew the correct adult malarial dosage for chloroquine or nivaquine. 125(40.4%) (95% CI: 34.4-46.7%) participants got their antimalarials from health centers, 27(10.6%) from shops, 24(9.5%) from hawkers, 23(9.1%) from the open market and 16 (6.3%) from herbalists. 66 (26.1%) (95% CI: 20.7-31.5%) participants knew the correct adult dosage for chloroquine or nivaquine treatment of malaria. 85(33.6%) (95% CI: 27.8–36.6%) participants had correct knowledge of malarial resistance. Of the 85 (33.6%) participants who had correct knowledge of antimalarial drug resistance, 52(20.6%) ascribed antimalarial drug resistance to continuous fever for a long time during treatment, 15 (5.9%) to serious fever during treatment and 18 (7.1%) when chloroquine does not stop fever. 23(27.1%) participants with correct knowledge of malarial resistance were in the 31-35 age group bracket compared with other age groups (P=0.1). There was a significant difference in correct knowledge of malarial resistance and participant’s profession (p=0.0). Conclusion: Malaria self-medication is common in Ndu but knowledge of antimalarial drug resistance is poor. Improvement in the self-treatment of malaria could be attained by providing clear information on choices of drugs for malaria treatment. Proper health information on the rational use of ant-malarial drugs must be provided in an appropriate manner to all groups of people in the society including village health workers, women associations, churches, school children, “Mngwah” opinion leaders, herbalists, health workers and chemists. Self-medication should be improved upon by giving correct information on the dosage of malaria treatment on radio, television, posters and newspapers because banning it will push many people to use it in hiding.Key words: Malaria, knowledge, practices, antimalarials, choices, sources, self-medication, resistance, Cameroo

A Critical Review on HIV/AIDS and Wound Care

Wound infections in AIDS patients increase discomfort, prolong hospital stay, render an additional burden upon an already debilitated patient and weaken the immune system further. Treatment must relate to the aetiology of the wound and take into account the patients underlying health problems. The treatment of wounds in HIV-AIDS patients is not different from the standard treatment. There are wound -related criteria for selecting the appropriate types of dressing. The best dressing for postoperative wound healing by secondary intention is unknown. Continuing wound evaluation and the appraisal of what dressing is useful for the type of wound and stage of healing is the basis of optimum wound care Optimum wound care, emotional support; health education will enhance both the emotional and physical wellbeing of the HIV-AIDS patient.Key words: Human immunodeficiency virus (HIV), Acquired immune deficiency syndrome (AIDS), wound infection, delayed wound healing, optimum wound care, dressing types, nutrition, and pain contro

Malaria prevention in the Buea health district in Cameroon: factors influencing Mosquito bed net use in households

Background: Insecticide treated bed nets (ITNs), though proven to be effective in preventing malaria will have little impact unless people sleep under them. Several studies have shown that owned ITNs are usually not used and that ITN use is influenced by several factors that vary between communities.Objective: To investigate the factors influencing the use of mosquito bed nets in households in the Buea Health District (BHD) in Cameroon.Material and Methods: A cross-sectional study with two-stage cluster sampling included 420 households from 35 sites. Questionnaires adapted from the Malaria Indicator Survey were used. CSPro 4.1 and Epi info 3.5.3 were used to create database and analyze respectively.Results: ITN ownership in the BHD was high (92.6%; 95% CI: 89.6%-94.9%) but ITN use was less than average (41.2%; 95% CI: 39.2%-43.3%). ITN use was least likely in the age group 5-15 years (P<0.01), in educated individuals (P<0.01) and in households with less than one ITN for two persons (P<0.01). White ITNs were less likely to be used (P<0.01). Conclusion: There is a gap between ITN ownership and use in the malaria holoendemic BHD and ITN use is associated with age of individual, level of education, colour of ITNs and household net density. Use of the highly owned ITNs could be increased by targeting the least protected 5-15 years age group and schooling individuals; by promoting school-based education on ITN use.Keywords: Insecticide-treated nets, malaria, Buea Health Distric

Epidemiological Studies on Proteeae Isolates from Clinical Specimens in the Laquintinie Hospital in Douala, Cameroon

The tribe Proteeae is a group of bacteria within the family Enterobacteriaceae and is responsible for most cases of nosocomial infections in hospital settings. The objective of this study was to determine the prevalence of members of Proteeae from clinical specimens in Laquintinie hospital in Douala. Specimens were collected from patients and screened for Proteeae using standard microbiological and biochemical methods (API 20 Enterobacteriaceae gallery). Of the 3414 clinical specimens made of 2712 urine, 264 blood, 243 CSF and 195 wounds and burns, 1136 (33.3%) yielded a positive bacterial growth, of which 230 (20.2%) were Gram positive and 906 (79.7%) were Gram negative. 164 (14.4%) isolates were identified as members of Proteeae of which 110 (67.1%) were from urine, 37( 22.6%) from wounds and burns, 10(6.1%) from blood and 7( 4.3%) from CSF. Speciation of the Proteeae isolates showed that 111 (67.7%) were Proteus mirabilis, 21(12.8%) Proteus vulgaris, 11 (6.7%) Providencia alcalifaciens, 6 (3.6%) Providencia stuartii, 4 (2.4%) Morganella morganii and 5 (3.0%) Proteus penneri and Providencia rettgeri. There was a significant difference between the type of clinical specimens and the age of patients (X2 = 52.623 p<0.05). Most Proteeae isolates where susceptible to imipemen, ceftazidine, chloramphenicol, gentamicin, nalidixic acid, ofloxacin and amikacin. These findings have significant clinical and epidemiological implications.Keywords: Proteeae isolates, Clinical specimens, Laquintinie Hospital, Cameroo

Typhoid Perforation Associated With Rectal Bleeding in HIV- Infected Patient

Typhoid (enteric) fever is a common worldwide water-borne disease generally transmitted via the faecal-oral route, the causative organism being the bacterium salmonella typhi. Intestinal perforation is a serious complication but the preoperative diagnosis of typhoid ulcer perforation can be difficult. The high incidence ofperforation has been attributed to late diagnosis and the emergence of multi-drug resistant and virulent strains of salmonella typhii. We report the simultaneous occurrence of intestinal perforation and bleeding complicating typhoid fever in a 42- year old Human immunodeficiency virus (HIV) infected patient.Both complications were simultaneouslytreated by an emergency ileo-caecal resection alongside antibiotic treatment of typhoid

A workshop report on promoting HIV/AIDS understanding through a capacity building train-the-trainer educational intervention

Nursing educators are frequently confronted with challenges that bring about innovation and transition to new ways of transferring knowledge in their home environments. These challenges are magnified when approached from an international perspective. Optimal implementation of knowledge transfer incorporates choosing models that promote local initiatives in line with increasingly decentralized educational structures. These decentralized models are a means to foster ongoing participation for both educators and students in their own professional development. Innovative education stems from creativity in approaching the need with formats and activities to meet a specific challenge. This experimental study builds upon previous study by the authors which was conducted in March, 2009, based upon the qualitative open focus forum at each of the five nursing programs. Overwhelmingly, the Cameroonian nursing students expressed a keen desire to study the HIV infected pregnant woman and the feeding options of the newborn. The study team developed the train-the-trainer program which was delivered at the University of Buea in the Southwest region of Cameroon in March, 2011. TTT is particularly effective for reaching large audiences and also permits a degree of sustainability such that the Cameroonian students will be trainers for subsequent cohorts of their peers. This study continues to strengthen the collaborative endeavors between the two nursing schools; the University of Buea (UB) and Goldfarb School of Nursing (GSON) at Barnes Jewish College in Saint Louis, Missouri, USA. The final aim of the intervention was the initiation of collaborative relationships between the faculty members of the two educational organizations.Key words: Workshop, HIV, AIDS, capacity building, education, intervention, Cameroo

Epidemiological Significance of the Colonization of Streptococcus Agalactiae in the Anorectum and Endocervix of Non-Parturients in Jos, Nigeria

Knowledge of Group B Streptococcus (GBS) carriage and infections in Africa is very scanty but few cases have been reported in Nigeria in particular. Streptococcus agalactiae has been reported to cause infections and diseases in non-parturients and adults ranging from bacteremia, osteomylitis, arthritis, and endocarditis to breast abscess among others, hence the necessity for this study. Fifty six non-pregnant women of different age groups and social status were screened for GBS in Plateau State Specialist Hospital using the Christie, Atkins and Munch-Petersen (CAMP) and hippurate hydrolysis tests. Two (3.6 %) of the 56 women were positive for GBS. The 2 isolates were all from the anorectum. The endocervix yielded no culture. The antibiogram showed that ampicillin is the drug of choice with all isolates (100%) sensitive to the drug. No statistically significant relationship was observed between the clinical and epidemiological characteristics of the patients and GBS carriage (P>0.05). This survey shows a much lower carriage proportion than that reported in Ibadan, Nigeria from non-parturients.Key words: Streptococcus agalactiae, epidemiology, anorectum, endocervix, non-parturient

Toxoplasma antibodies amongst HIV/AIDS patients attending the University Teaching Hospital Yaounde in Cameroon

Toxoplasmosis is caused by an obligatory intracellular protozoon. It causes a wide range of diseases with toxoplasma encephalitis commonly encountered in HIV/AIDS patients. This work was carried out to determine the seroprevalence of toxoplasma antibodies (IgM and IgG) in HIV/AIDS patients attending the Yaoundé University Teaching Hospital (UTH) in Cameroon. Sera were collected from 133 HIV/AIDS patients at the out-patient department and the ELISA technique was employed serologically to determine toxoplasma antibodies. Of the 133 patients 83 (62.4%) were females and 59 (37.6%) were males; ninety three (69.9%) were positive for toxoplasma antibodies. Fourteen (10.8%) of the 93 of seropositive patients presented with both IgG and IgM-antibodies in their sera while fifty six (42.1%) and 8 (6.0%) were only sero-positive for toxoplasma IgG or IgM-antibody respectively This rate of infection was not dependent on the patient’s sex or age (X2=11.49, P>0.05). The data provides enough evidence to conclude that 64.7% of the positive cases were due to reactivated infection.Key words: Toxoplasmosis, HIV/AIDS, Pregnancy, Risk factors, Prevalence, Yaounde, Cameroon.doi: 10.4314/ajcem.v12i3.

Prevalence of septicaemia and antibiotic sensitivity pattern of bacterial isolates at the University Teaching Hospital, Yaoundé, Cameroon

Bloodstream infections are important causes of mortality and morbidity. Rapid empiric antibiotic therapy is often needed. Knowledge of epidemiological data of common pathogens and their antibiotic sensitivity pattern is needed for rapid therapy. This study was aimed at determining the common causes of septicaemia and their antibiotic sensitivity pattern from the University Teaching Hospital, Yaoundé. Blood samples were collected and cultured aerobically. Isolates were identified using bacteriological and biochemical methods and antibiotic sensitivity was done using the Kirby- Bauer disc diffusion method. Results showed that of the 396 patients examined 112 (28.3%) had septicaemia. Children below the age of 15 years constituted the greatest percentage of infected subjects (63.4%) followed by patients aged between 16-30 years (10.7%) (P < 0.05). The highest incidence of septicaemia were from medicine (8.95‰), followed by paediatrics (7.04‰), surgery (6.46 ‰), out-patients (5.79‰), neonatology (5.12‰), obstetrics and gynaecology (5.05‰) and emergency (2.05‰) wards. The overall incidence of septicaemia was 5.79 per 1000 admissions. Gram-positive bacteria were encountered more often than gram negative bacteria (56.2% versus 43.8%,

Seroepidemiology of Toxoplasmosis in Pregnant Women Attending the University Teaching Hospital in Yaounde, Cameroon

Purpose: The study was carried out to investigate the epidemiology and associated toxoplasmosis predisposing risk factors in Cameroon. Methods: The survey took place at the Yaounde University Teaching Hospital from May to June 2008. Serum samples were collected from 110 pregnant women attending the ante natal clinic using aseptic techniques after obtaining informed consent. The samples were analysed using toxo-lgG immunocomb and toxo-IgM &ldquo;capture&rdquo; ELISA. A structured questionnaire was used to collect information on predisposing risk factors for toxoplamosis from each patient. Data was analysed on Epi-Info using confidence intervals and chi-square statistic test. Results: The average age of the women was 27.9+5.8years and the mean gestational age was 4.1+0.2months. The overall IgG seroprevalence was 65.5% {95% CI: 53.7-71.7%} and that of IgG and IgM co-infection was 2.7%. The seroprevalence was 75% in the first trimester, 60.6% in the second trimester and 50% in the third trimester. No statistically significant relationships were established between anti-toxoplasma IgG and IgM antibodies and abortion history, meat consumption, potable water sources, cat ownership and age. Conclusion: The prevalence of IgG antibodies to Toxoplasma gondii is high and the first trimester in pregnancy carries the highest risk. All pregnant women should be screened for toxoplasmosis and educated on predisposing risk factors during antenatal visits.Keywords: Toxoplasma gondii, Pregnancy, IgG, IgM, Prevalenc